Introduction to Positive Behaviour Support Under the NDIS
Published: 27 September 2021
Some National Disability Insurance Scheme (NDIS) participants require additional support to manage potentially harmful behaviours. In escalating situations, this might require the use of regulated restrictive practices in order to prevent an emergency or protect the participant and those around them.
As these types of supports have been identified as high-risk (i.e. potentially causing harm to the participant and others around or supporting them), there are specific requirements that providers must follow (NDIS 2020).
What are Changed Behaviours?
Note: Changed behaviours are often referred to as ‘behaviours of concern’ or ‘challenging behaviours'. However, the term 'changed behaviours' is now recommended as it avoids negatively stigmatising people who display behaviours that indicate a need for support (DSA 2021).
Sometimes, NDIS participants will display behaviours that indicate they require extra support. These are known as changed behaviours/behaviours of concern. Often, these behaviours are a signal that the person is experiencing stress, wants to communicate something or has an unmet need (DSA 2021).
Some of these behaviours may pose a risk of harm to the NDIS participants themselves and other people or objects (Scope 2009).
Examples of high-risk behaviours that could be potentially harmful to the person and those around them include:
Self-harm (e.g. hurting, hitting or scratching themselves)
Hurting others (e.g. hitting, pinching, biting)
Refusing to do something (e.g. eating, taking medicine)
Screaming or swearing
Hiding from other people.
Why Do Changed Behaviours Occur?
There are a variety of reasons why someone might display changed behaviours/behaviours of concern. Often, there are multiple factors at play (Scope 2009).
These might include:
Being in pain or feeling unwell
Biological needs (e.g. being hungry or thirsty, needing to use the toilet)
Wanting to communicate something, go to a certain place or do a particular activity
Wanting a tangible object
Feeling overstimulated (e.g. too many people around)
Feeling uncomfortable in their environment (e.g. too hot or too cold, too noisy or too quiet, unpleasant smells)
Feeling upset, lonely, bored etc.
Seeking companionship, interaction or relationships
Wanting to protest, escape, avoid, reduce or delay something
(Scope 2009; VIC DoHHS 2020)
Positive Behaviour Support
The Positive Behaviour Support Capability Framework
The PBS Capability Framework outlines the expectations for best-practice behaviour support for NDIS participants (NDIS 2019b).
What is Positive Behaviour Support?
As part of their Zero Tolerance initiative, the NDS has released a series of five films on positive behaviour support. View them here.
The term positive behaviour support (PBS) is defined as ‘the integration of the contemporary ideology of disability service provision with the clinical framework of applied behaviour analysis’ (NDIS 2019).
PBS uses evidence-based strategies to improve the quality of life of those living with disabilities and reduce changed behaviours/behaviours of concern (NDIS 2019).
PBS is underpinned by respect, dignity, empathy, choice, person-centredness and unconditional positive regard (NDS 2017).
The belief is that with appropriate support, and in the right environment, changed behaviours/behaviours of concern can be reduced using positive strategies (Openminds 2019).
PBS can help to reduce changed behaviours/behaviours of concern by:
Helping the participant to be understood
Adjusting the participant’s environment so that they feel more comfortable
Improving the participant's lifestyle by providing them with opportunities to connect with the community and allowing them to participate in activities they enjoy
Helping the participant to foster meaningful relationships with others
Ensuring the support environment is encouraging, fun and understanding.
Effective PBS strategies focus on:
Changing environmental factors that lead to changed behaviours/behaviours of concern
Teaching the participant new skills to replace changed behaviours/behaviours of concern
Teaching the participant skills that increase their independence and quality of life
Providing a framework to educate support workers and others on how to best respond to and modify the participant’s environment.
Positive Behaviour Support Plans
What is a Positive Behaviour Support Plan?
PBS also involves the development and implementation of positive behaviour support plans in order to support NDIS participants who display changed behaviours/behaviours of concern.
A PBS plan is developed based on a behaviour support assessment that has been undertaken (ACSA 2020). It may include regulated restrictive practices if required (Disability Support Guide 2020).
The PBS plan addresses a person’s needs and identifies complex changed behaviours/behaviours of concern. It sets out individualised, evidence-based strategies that can be used to respond to these behaviours and improve the person’s quality of life (NDIS 2018; ACSA 2020).
Research has shown that high-quality PBS plans not only improve the quality of supports being delivered but are associated with a decrease in the use of restrictive practices (VIC DoHHS 2020).
A PBS plan that contains a restrictive practice should be reviewed at least every 12 months (Disability Support Guide 2020).
What is an Interim Positive Behaviour Support Plan?
An interim positive behaviour support plan is a brief, temporary plan that is developed when there is an immediate need for behaviour support. It is used until a positive behaviour support assessment has been undertaken. (ACSA 2020).
What Does a Positive Behaviour Support Plan Look Like?
Sample PBS plans from the NDIS Commission can be found below:
Be developed by an NDIS behaviour support practitioner
Clearly identify any restrictive practices and include:
Plans for eliminating and reducing the use of the restrictive practice
Plans for monitoring and reviewing
Be developed within six months of the behaviour support practitioner being engaged (or within one month for an interim plan)
Be developed in consultation with the NDIS participant and their family members, carers, implementing provider, guardians and/or any other relevant parties
Be informed by a behaviour support assessment
Contain evidence-based, person-centred, proactive strategies for addressing changed behaviours/behaviours of concern
Be lodged with the NDIS Commission if regulated restrictive practices are included in the plan.
What is Specialist Behaviour Support?
Specialist behaviour support involves:
Performing functional behaviour support assessments
Developing positive behaviour support plans.
Who is Responsible for Providing Specialist Behaviour Support?
Specialist behaviour support must be delivered by an NDIS behaviour support practitioner - a specialist whom the NDIS Commission has assessed using the Positive Behaviour Support Capability Framework and deemed suitable to perform functional behaviour support assessments and develop positive behaviour support plans (NDIS 2018, 2019a, 2021).
Changed behaviours/behaviours of concern can be challenging to manage. However, it is important to consider why they may be occurring. By developing and implementing a behaviour support plan, these behaviours can be managed in a positive way that allows the participant’s needs to be addressed and improves their quality of life.
Note: Providers should be guided by their organisational policies. Always refer to your organisation’s policies and procedures.